Efficacy of Silver-Based gel Compared With Fusidic Acid Cream in Topical Treatment Following Trichloroacetic Acid Facial Skin Peeling

A Pilot Study

Geva Landau, MD; Sami Gabario, MD; Shaked Menashe, MD; Hodaya Saadon, BSc; Lior Heller, MD

Disclosures

Wounds. 2018;30(12):363-366. 

In This Article

Abstract and Introduction

Abstract

Background: Trichloroacetic acid (TCA) is a nontoxic chemical that has been used for more than 20 years in skin rejuvenation treatments for various skin conditions. Currently, there is no single accepted protocol for local burn care following TCA peeling.

Objective: This pilot study assesses the efficacy and tolerability of a silver-based gel compared with fusidic acid cream as a complementary topical treatment for burns following TCA peeling.

Materials and Methods: The authors conducted a comparative study on healthy female patients in the Department of Plastic and Reconstructive Surgery at Assaf Harofe Medical Center (Zerifin, Israel). Patients were treated with TCA 15% for superficial facial skin peeling, followed by applications of both the silver-based gel and fusidic acid cream on opposite sides of their face. Patient evaluation included high-resolution photographic evaluation pre- and post-peeling; physician assessment for the presence of complications such as infection, edema, and allergic reactions; and a self-completed questionnaire in reference to the outcomes and side effects (eg, burning, itching) experienced.

Results: Seventeen women were included in the study. None of the patients experienced an infection or allergic reaction. Photographic analysis found no significant differences in the outcomes between topical treatments, with a trend for better results with the silver-based gel. Pain, edema, and burning sensations were not significantly different between the topical treatments. Itching was less prevalent in the silver-based gel group (P = .046).

Conclusions: Comparing between the groups treated with silver-based gel and fusidic acid cream, the authors found no inferiority in the outcomes or the prevalence of any complaints, and a superior effect on the prevention of wound itch using a silver-based gel.

Introduction

Trichloroacetic acid (TCA) is a nontoxic chemical that has been used for more than 20 years in skin rejuvenation treatments for various skin conditions, such as acne scars, melasma, sun damage, and other skin diseases.[1–4]

Use of low concentrations of TCA (10%–35%) causes a first-degree or superficial second-degree burn to the skin, removing the superficial layers and peeling the skin's epidermis within a few days of application. This superficial removal prompts the wound healing process to regenerate the skin.[1,2] In common practice, TCA peeling usually is combined with topical antibacterial agents to prevent posttreatment skin infections and alleviate discomfort.[5] Although infection following chemical peeling is rare,[6] there are several reports of patients developing toxic shock syndrome after such treatments.[7] Therefore, the antibacterial topical treatment is primarily aimed against Staphylococcus aureus infections.[8] A second important function of the topical treatment is relieving some of the discomfort associated with the burn healing process.[5,9]

In 2016, the global wound care market was estimated at $18.2 billion,[10] and, naturally, there is a wide variety of ointments, creams, and other topical applications for the treatment of various types of wounds, including burns, ulcers, and abrasions. As is the case for many other types of wounds, there is no single accepted protocol for local burn care following peeling, but physicians often use common anti-staphylococcal agents, such as 2% fusidic acid cream(Fucidin; LEO Pharma, Ballerup, Denmark).[5,11] Agents containing silver ions are known for their antibacterial and anti-inflammatory traits and are in common use in treating wounds as well as first- and second-degree burns.[12,13] Despite their wide use in the treatment of burns, silver-based agents are not commonly used for treating facial skin after peeling.

SilvrSTAT gel (ABL Medical LLC; American Fork, Utah) is a nanosilver-based gel (active ingredients: nanosilver 32 parts/million) commonly used in the treatment of all degrees of pressure ulcers, diabetic ulcers, traumatic wounds (ie, wounds with complete epidermal loss), first- and second-degree burns, and various types of colonized or infected wounds.[14]

This pilot study was conducted to assess the efficacy and tolerability of the silver-based gel compared with fusidic acid cream as a topical treatment for burns following TCA peeling. The conclusions from this study will help determine the safety and design of a future larger scale study.

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